A chatty e-mail from Arnold lists the practical difficulties of treating the disease in the field:
— Diagnosis demanding and prolonged. Patients must bring sputum samples on consecutive days.
— Lab work essential but microscopes often busted or stolen.
— No dye available to detect bacilli. Dye sold, drunk, run out, not replaced.
— Treatment takes eight months. Patients who feel better after a month abandon treatment or sell pills. Disease then returns in drug-resistant form.
— TB pills are traded on African black markets as cures for STD'S (sexually transmitted diseases). The World Health Organization insists that a patient taking a tablet should be watched while he or she swallows it. Result: a black market pill is sold "wet" or "dry" according to whether it's been in someone's mouth…
A bald postscript continues:
TB kills more mothers than any other disease. In Africa, women always pay the price. Wanza was a guinea pig, and became a victim.
As whole villages of Wanzas were guinea pigs.
* * *
Extracts from a page-four article in the International Herald Tribune:
"West Warned it, too, is Vulnerable to Drug-Resistant Strains of TB" by Donald G. McNeil Jr., New York Times Service,
some passages highlighted by Tessa.
AMSTERDAM — DEADLY strains of drugresistant tuberculosis are increasing not just in poor countries but in wealthy Western ones, according to a report from the World Health Organization and other anti-Tb groups.
"It's a message: Watch out, guys, this is serious," said Dr. Marcos Espinal, the lead author of the report. "It's a potential major crisis in the future"…
But the most powerful weapon that the international medical community has for raising money is the specter that the unchecked explosion of cases in the Third World will let divergent strains merge into something incurable and highly contagious that will attack the West.
(footnote by Tessa, written in a mysteriously restrained hand, as if she is deliberately holding herself back from sensation:
"Arnold says, Russian immigrants to U.S., particularly those coming straight from the camps, carry all sorts of multiresistant strains of TB — ACTUALLY in a higher proportion to Kenya, where multi-resistant is NOT synonymous with HIV'-POSITIVE. A friend of his is treating very bad cases in Brooklyn's Bay Ridge area, and numbers are already frightening, he says. Incidence throughout U.S., amid crowded urban minority groups, said to be constantly increasing."
Or, put into the language that stock exchanges the world over understand: If the TB market performs as forecast, billions and billions of dollars are waiting to be earned, and the boy to earn them is Dypraxa — always provided, of course, that the preliminary canter over the course in Africa has not thrown up any disturbing side effects.
It is this thought that prompts Justin to return, as a matter of urgency, to the Uhuru Hospital in Nairobi. Hastening to the counting table, he again rummages in the police files and unearths six photocopied pages covered in Tessa's fever-driven scrawl as she struggles to record Wanza's case history in the language of a child.
Wanza is a single mother.
She can't read or write.
I met her in her village and again in Kibera slum. She got pregnant by her uncle who raped her and then claimed she had seduced him. This is her first pregnancy. Wanza left the village in order not to be raped again by her uncle, and also by another man who was molesting her.
Wanza says many people in her village were sick with bad coughs. Many of the men had AIDS, women too. Two pregnant women had recently died. Like Wanza, they had been visiting a medical center five miles away. Wanza did not want to use the same medical center any more. She was afraid their pills were bad. This shows that Wanza is intelligent since most native women have a blind faith in doctors, though they respect injections above pills.
In Kibera, a white man and a white woman came to see her. They wore white coats so she assumed they were doctors. They knew which village she had come from. They gave her some pills, the same pills she is taking in hospital.
Wanza says the man's name was Law-bear. I get her to say it many times. Lor-bear? Lor-beer? Lohrbear? The white woman who came with him did not speak her name but examined Wanza and took samples of her blood, urine and sputum.
They came to see her in Kibera twice more. They were not interested in other people in her hut. They told her she would be having her baby in the hospital because she was sick. Wanza was uneasy about this. Many pregnant women in Kibera are sick but they did not have their babies in hospital.
Lawbear said there would be no charges, all of the charges would be paid on her behalf. She did not ask who by. She says the man and woman were very worried. She did not like them to be so worried. She made a joke of this but they did not laugh.
Next day a car came for her. She was close to full term. It was the first time she had ridden in a car. Two days later Kioko her brother arrived at the hospital to be with her. He had heard she was in the hospital. Kioko can read and write and is very intelligent. Brother and sister love each other very much. Wanza is fifteen years old.
Kioko says that when another pregnant woman in the village was dying, the same white couple came to see her and took samples from her just as they had done with Wanza. While they were visiting the village they heard that Wanza had run away to Kibera. Kioko says they were very curious about her and asked him how to find her and wrote his instructions in a notebook. That is how the white couple found Wanza in Kibera slum and had her confined in the Uhuru for observation. Wanza is an African guinea pig, one of many who have not survived Dypraxa.
* * *
Tessa is talking to him across the breakfast table. She is seven months pregnant. Mustafa is standing where he always insists on standing, just inside the kitchen but listening at the partly opened door so that he knows exactly when to make more toast, pour more tea. Mornings are a happy time. So are evenings. But it is in the morning that conversation flows most easily.
"Justin."
"Tessa."
"Ready?"
"All attention."
"If I yelled Lorbeer at you — pow, just like that — what would you say to me?"
"Laurel."
"More."
"Laurel. Crown. Caesar. Emperor. Athlete. Victor."
"More."
"Crowned with — bay — bay leaves — laurel berry — rest on one's laurels — bloody laurels, victory won by violent war — why aren't you laughing?"
"So German?" she insists.
"German. Noun. Masculine."
"Spell it."
He did.
"Could it be Dutch?"
"I should think so. Nearly. Not the same but close, probably. Have you taken up crosswords or something?"
"Not anymore," she replies thoughtfully. And that, as quite often with Tessa the lawyer, is that. Compared with me, the grave is a chatterbox.
* * *
No J, no G, no A, her notes continue. She means: Justin, Ghita and Arnold are none of them present. She is alone in the ward with Wanza.
15:23 Enter beef-faced white man and tall Slav-looking woman in white coats, Slav's open at the neck. Three other males in attendance. All wear white coats. Stolen Napoleonic bees on pockets. They go to Wanza's bedside, gawp at her.
Self: Who are you? What are you doing to her? Are you doctors?
They ignore me, stare at Wanza, listen to her breathing, check heart, pulse, temp, eyes, call "Wanza." No response.
Self: Are you Lorbeer? Who are you all? What are your names?